AMAÇ: En sýk yaþamý tehdit eden acil durumlardan biri ekstremite kanamasýdýr. Bu gibi durumlarda hastanýn hayatta kalmasý, olay yerinde hýzlý müdahaleye baðlýdýr. Bu nedenle, hem potansiyel tanýklar hem de týbbi acil durum personeli kanamalarý kontrol etme yeteneðine sahip olmalýdýr. Ancak simülatör temelli kurslar, insan vücudunun yapýlarýný ve fizyolojisini tam olarak yansýtmamaktadýr. Bu nedenle, travma hastalarýnda invaziv prosedür eðitimi sýnýrlýdýr. Bu çalýþmanýn amacý, ekstremite kanama kontrolünde Combat Application Tourniquet (CAT) kullanýmýnýn eðitimi sýrasýnda bir eðitim aracý olarak kadavra kullanýmýnýn etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþma simüle edilmiþ kanamalý, taze bir insan kadavrasýnýn üst ekstremitesine turnike uygulayan 31 saðlýk görevlisi öðrencisi arasýnda gerçekleþtirildi. Ýki kez ölçüm yapýldý, ikincisinden önce bir insan kadavrasý üzerinde kýsa bir CAT uygulama eðitimi verildi.
BULGULAR: Ýlk denemede simüle edilmiþ kanamayý durdurmak için gereken ortalama süre 38.33 saniyeydi (SD±35.14). Eðitim sonrasý ortalama süre 20.58 saniyeye düþtü (SD±5.77). Bu iki deðer arasýnda istatistiksel olarak anlamlý bir fark gözlendi (p=0.004).
TARTIÞMA: Çalýþma, insan kadavralarý üzerinde yapýlan eðitimde CAT kullanýmýnýn, etkinlikte önemli bir iyileþme saðladýðýný göstermiþtir. Kadavralar, yeterli hazýrlýðýn ardýndan, ekstremite kanama kontrolü gibi invaziv týbbi prosedürlerin uygulanmasýna izin veren yüksek kaliteli birer eðitim araçlarýdýr.

BACKGROUND: One of the most frequent life-threatening emergencies is extremity haemorrhage. In such cases, patient survival depends on a fast on-scene intervention. Thus, both the potential witnesses and medical emergency staff should have the ability to control haemorrhages. However, simulator-based courses do not fully reflect the structures and physiology of the human body. Therefore, invasive procedure training in trauma patients is limited. The present study aims to evaluate the effectiveness of cadavers as educational tools during a training course in extremity haemorrhage control with the use of the Combat Application Tourniquet (CAT).
METHODS: This study was conducted among 31 paramedic students, who applied a tourniquet to the upper extremity of an unembalmed (fresh) human cadaver with simulated bleeding. Two time measurements were performed, the latter being preceded by a short CAT application training on a human cadaver.
RESULTS: The mean time needed to stop the simulated bleeding in the first attempt was 38.33 seconds (SD±35.14). After the training, the mean time decreased to 20.58 seconds (SD±5.77). A statistically significant difference was observed between these two values (p=0.004).
CONCLUSION: This study demonstrated that training conducted on human cadavers led to a significant improvement in the effectiveness of CAT use. Cadavers constitute a high-quality educational tool that, after adequate preparation, allows for practicing invasive medical procedures, such as extremity haemorrhage control.

AMAÇ: Bu çalýþmanýn amacý peritonitli ortamda yapýlmýþ olan sol kolon anastomozlarýnýn güveliðinin klorheksidin emdirilmiþ kompres ve metronidazol emdirilmiþ kompres kullanýmý ile incelenmesidir.
GEREÇ VE YÖNTEM: Üç eþit gruba ayrýlmýþ 21 Wistar Albino sýçan kullanýlarak çalýþma hazýrlandý. Median laparatomiden sonra pelvik peritonun 2 cm üzerinden kolon tam kat olarak kesildi. Fekal kontaminasyon amaçlý feçes yarlanma alanýnýn çevresine yayýldý. Ardýndan fasia ve cilt 3/0 ipekle kapatýldý. Bir gün sonra relaparatomi yapýldý. Ýlk grupta anastomoz öncesinde batýn izotonik sodyum klorür emdirilmiþ materyalle temizlendi ve ardýndan çift kat anastomoz uygulandý. Grup II’de batýn metronidazol emdirilmiþ materyallerle temizlendikten sonra çift kat anastomoz uygulandý. Grup III’te batýn klorheksidin glukonat emdirilmiþ materyal ile temizlendikten sonra çift kat anastomoz uygulandý. Ameliyat sonrasý 10. günde relaparatomi yapýlarak doku hidroksiprolin düzeyleri, anastomoz patlama basýnçlarý ölçüldü ve anastomoz hattýnýn histopatolojik bulgularý incelendi.
BULGULAR: En yüksek anastomoz patlama basýncý Grup-III’te tespit edildi (p<0.05 Group I-III, Group II-III). En yüksek doku hidroksiprolin düzeyleri Grup III’te tespit edildi (p<0.005 Group I-III, Group II-III). Üç grup arasýnda histopatolojik bulgular deðerlendrildiði zaman Grup II ile Grup III arasýndaki iyileþme skorlarý arasýnda anlamlý farklýlýk izlenmezken, Grup I ile karþýlaþtýrýldýðýnda hem Grup II hem de Grup III’te iyileþme skorlarý istatsitiksel olarak anlamlý derecede yüksekti (p<0.05 Group I-III and Group I-II).
TARTIÞMA: Antibakteriyel ajan emdirilmiþ materyalle anastomoz öncesinde batýnýn temizlenmesi peritonitli ortamda rezeksiyon güvenliðinin ve primer anastomoz güvenliðini arttýrmaktadýr.

BACKGROUND: The present study aims to evaluate the use of the chlorhexidine gluconate and metronidazole impregnated compresses concerning anastomosis safety in the left colonic anastomosis in the presence of peritonitis.
METHODS: This study was conducted on 21 Wistar-Albino-rats divided into three equal groups. After median laparotomy, the whole layer of the left colon was cut 2 cm over the pelvic peritoneum. The faeces were spread around the injury for fecal contamination. Then, fasia and skin were closed with 3/0 silk. After one day period, relaparatomy was performed. The abdomen was cleared isotonic sodium chloride with impregnated material before starting colonic anastomosis in the first group and then double layer colonic anastomosis was performed. In the second Group-II, abdomen was cleared with the metronidazole impregnated compresses then double layer colonic anastomosis was performed. In the group-III, abdomen was cleared with the chlorhexidine gluconate impregnated compresses then double layer colonic anastomosis was performed. Tissue hydroksiproline levels and anastomosis bursting pressures were measured and histopathologic findings on the anastomosis line were evaluated on the postoperative tenth day by performing relaparatomy.
RESULTS: The highest anastomosis bursting pressure was found in Group-III (p<0.05). The highest tissue hydroksiproline level was found in Group-III (p<0.005 Group I-III, Group II-III). When histopathologic findings were evaluated by comparing the three groups in this study, the healing of the intestine tissue score was statistically insignificant between group-II and III, for both group-II and III, healing score was statistically significant higher than Group-I (p<0.05 Group I–III and Group I-II).
CONCLUSION: Cleaning the abdomen before the anastomosis using antibacterial soaked material increased resection safety in the presence of peritonitis and anastomosis safety in primary anastomosis.

AMAÇ: Acil týbbi yardým ekibi simülasyonunun toplum-temelli afet tatbikatýnda bilgi ve tutumlar üzerindeki etkisini deðerlendirdik.
GEREÇ VE YÖNTEM: 2006 yýlýndan 2008’e kadar Seul Metropolitan Þehir bölgesindeki toplum saðlýðý merkezleri, acil servisler, itfaiye istasyonlarý, acil týp teknisyenleri akademisi ve acil durum bilgi merkezinden iþe alýnan katýlýmcýlar için didaktik dersler, masabaþý simülasyonu ve açýk alan simülasyonunu içeren sekiz saatlik afet tatbikatlarý geliþtirildi. Tatbikattan önce ve sonra tasarlanmýþ anketi kullanarak bilgi ve tutum üzerine anket yaptýk. Deðiþiklikleri t-testi ve tekrarlayan ölçüm ANOVA analizi ile karþýlaþtýrdýk.
BULGULAR: Çalýþma süresince toplam 14 toplum-temelli tatbikat yapýlmýþtýr. Hem tatbikat öncesi hem de sonrasý ankete 525 (%79.4) kiþi yanýt verdi. Bunlarýn içerisinde doktorluk, gönüllü öðrencilerden (%47.1) sonra ikinci yaygýn meslekti (%26.9). Genel olarak, bilgi ve tutum puaný sýrasýyla 3.9±1.0’dan 4.3±0.9’a (p<0.001) ve 21.4±3.4’ten 22.4±3.2’ye (p<0.001) anlamlý olarak artmýþtýr. Mesleki lisans gruplarý arasýnda tatbikat öncesi ve sonrasý bilgi düzeyi arasýndaki fark anlamlýydý (p=0.03), tatbikat öncesi ve sonrasý tutum açýsýndan meslekler arasýndaki fark ise anlamlý deðildi (p=0.78).
TARTIÞMA: Acil Týbbi Yardým Ekibi’nin kurulmasý ve iþletilmesine iliþkin afet tatbikatý, katýlýmcýlarýn hem bilgi hem de tutumlarýný olumlu etkileyebilir.

BACKGROUND: We evaluated the effects of community-based disaster drill of simulating disaster medical assistance team on the knowledge and the attitudes.
METHODS: Eight hours disaster drills, including didactic lectures, table simulation, and outdoor field simulation, were developed for participants who were recruited from community health centers, emergency departments, fire stations, emergency medical technicians’ academy, and emergency information center in the Seoul Metropolitan City area from 2006 to 2008. We surveyed on the knowledge and the attitude using designed questionnaire before and after drill. We compared changes using t-test and repeated measure ANOVA.
RESULTS: In this study, 14 community-based drills were performed and 525 (79.4%) people responded to both pre- and post-drill survey. Of these, the doctor was the second common occupation (26.9%) after volunteer students (47.1%). Overall, knowledge and attitude score significantly increased from 3.9±1.0 to 4.3±0.9 (p<0.001) and from 21.4±3.4 to 22.4±3.2 (p<0.001), respectively. The difference among professional license groups between pre- and post-drill knowledge level was significant (p=0.03), while the difference among jobs for attitude between pre- and post-drill was not different (p=0.78).
CONCLUSION: Disaster drills on the establishment and operation of DMAT may affect both knowledge and attitude of participants positively.

AMAÇ: Bu çalýþmada amaç, COVID-19 pandemisinde sýk görülen proktolojik hastalýklara acil, yarý-acil ve elektif koþullarda nasýl yaklaþýlmasý gerektiðini gösteren pratik bir kýlavuz hazýrlamaktýr.
GEREÇ VE YÖNTEM: Pandemi döneminde ilgili kýlavuzlarla iliþkili olarak, sýk görülen anorektal hastalýklarýn taný ve tedavisinde, hastalarý doðru yönlendirmek amaçlý hastane baþvuru öncesi teletýp ile deðerlendirilmiþtir. Ayný zamanda proktoloji ünitelerinde kontaminasyon ve enfeksiyonu kontrol etmek için önlemler alýnmýþtýr. Sýk görülen anorektal hastalýklarýn COVID-19 pandemisinde acil ve elektif koþullarda deðerlendirilmesini kolaylaþtýrýcý kýlavuz oluþturulmuþ, bu amaca hizmet için pandemi döneminde hastalarýn erken sonuçlarý dokümante edilmiþ, geriye dönük olarak irdelenmiþtir.
BULGULAR: Ýki merkezde 1 Mart ile 10 Nisan 2020 tarihleri arasýnda anorektal hastalýklarý olan 240 hasta ile iletiþime geçildi. Hastalar 16–17 Nisan’da geriye dönük olarak deðerlendirildi. On dört (%5.8) hasta ile takip sýrasýnda iletiþim kurulamadý. Otuz bir hasta (%12.9) ise þiddetli proktolojik þikayetleri nedeni ile proktoloji ünitelerine davet edildi. Bu hastalarýn 28’ine ayný seansta acil giriþim uygulandý. Hazýrladýðýmýz proktoloji rehberi sayesinde %2.1’i þüpheli kontaminasyon olan hastalarýn anorektal hastalýklarýnýn %90’dan fazlasý baþarýlý bir þekilde tedavi edildi. Proktroloji personelinde ve yakýn temaslý olan kiþilerde bu pratik proktoloji kýlavuzu sayesinde COVID-19 saptanmadý.
TARTIÞMA: Hazýrlanan pratik kýlavuzda belirtilen ilkelere baðlý kalarak, acil ve elektif selim anorektal hastalýklarýn çoðunluðu COVID-19 salgýnýnýn ilk, telaþlý döneminde güvenli bir þekilde tedavi edilebilmiþtir.

BACKGROUND: This article aims to give practical information and concrete suggestions on what should be considered in emergency, semi-urgent and elective settings for common anorectal diseases in the hectic period of the COVID-19 pandemic, based on early results of a series of anorectal interventions.
METHODS: Referring to other related guidelines, general considerations specific to the diagnosis and treatment of highly prevalent anorectal diseases were developed to target the correct patients, evaluate and orientate by telemedicine, adapt the Proctology Unit to the new pandemic, and control contamination and infection. Specific considerations for common anorectal diseases were cited, and our initial results were retrospectively documented.
RESULTS: From March 1 to April 10, 2020, we contacted 240 patients with anorectal diseases in two centers. We evaluated the results retrospectively on 16–17 April. At the end of this survey, 14 patients (5.8%) were lost for further contact and follow-up. Thirty-one patients (12.9%) were evaluated as nondeferrable cases and invited to the Proctology Unit. Twenty-eight patients required interventions at the same session. Adhering to the principles described here, more than 90 percent of benign anorectal disorders could be treated successfully, with 2.1 percent of suspected contamination and no confirmed cases. None of the Proctology personnel or their close contacts developed COVID-19, either.
CONCLUSION: By adhering to the principles outlined in this practical guide, it was possible to treat most of the benign anorectal diseases safely in the initial, hectic period of the COVID-19 pandemic.

AMAÇ: Akut apandisitlerde hastanýn yaþý, komorbiditesi ve apendiksin komplike olup olmamasýna göre hastaya uygulanacak tedavi yaklaþýmý deðiþebilir. Bu çalýþmada, komplike apandisit lojistik regresyon modelini içeren AppendistatTM skorunun doðrulamasýný yapýp ayný zamanda appendistatTM skoru ile C-reaktif protein’in komplike apendisitleri ön görmedeki etkinliðini karþýlaþtýrdýk.
GEREÇ VE YÖNTEM: Akut apandisit nedeniyle hastanemizde apendektomi yapýlan hastalarýn demografik özellikleri, patoloji ve laboratuvar sonuçlarý geriye dönük olarak tarandý. On sekiz yaþ üzeri apendektomi yapýlan hastalar çalýþmaya dahil edildi. Komplike apandisit lojistik regresyon modelini içeren AppendistatTM skoru kullanýldý.
BULGULAR: On üç (%10.1) hastada komplike ve 116 (%89.9) hastada non-komplike apandisit izlendi. Komplike apandisitlerin 2’si (%15.4) kadýn 11’i (%84.6) erkekti. Komplike apandisitlerin yaþ ortalamasý 44 (20–77) yýl ve C-reaktif protein’in median deðeri 41.00 mg/L idi. ROC eðri analizinde c-reaktif protein için kestirim deðeri 23.5mg/L olarak bulundu. AppendistatTM skoru için kestirim deðeri 9.6 olarak bulundu. AppendistatTM skoru ve C-reaktif protein’in Area Under the Curve’ü sýrasýyla 0.787/0.750 idi.
TARTIÞMA: AppendistatTM skoru doðru parametreleri içeren baþarýlý bir skorlama sistemidir. C-reaktif protein parametresinin de komplike apandisitleri benzer oranda belirleyebilmesi ya da dýþlayabilmesi göz önüne alýndýðýnda; klinik uygulamada bu skorlama sisteminin belirgin üstünlüðü olmadýðýný düþündürmektedir.

BACKGROUND: In acute appendicitis, the treatment approach may vary depending on the age and comorbidities of the patient and whether the appendix is complicated. In this study, we validated the appendistatTM score, including the logistic regression model of complicated appendicitis, and compared the efficacy of this scoring with C-reactive protein in predicting complicated appendicitis.
METHODS: Demographic characteristics, pathology, and laboratory results of patients who underwent appendectomy for acute appendicitis were retrospectively screened, those over 18 years of age were included in the study. The appendistatTM scores, including the logistic regression model of complicated appendicitis, were obtained.
RESULTS: Complicated appendicitis was present in 13 (10.1%) patients and non-complicated appendicitis in 116 (89.9%). Two (15.4%) of the complicated appendicitis cases were female and 11 (84.6%) were male. The mean age of complicated appendicitis cases was 44 (20–77) years, and their median value of C-reactive protein was 41.00 mg/L. In the ROC curve analysis, the cut-off value for C-reactive protein was 23.5 mg/L and that of the appendistatTM as 9.6. The area under the curve values of the appendistatTM score and C-reactive protein were 0.787 and 0.750, respectively.
CONCLUSION: AppendistatTM is a successful scoring system that contains appropriate parameters. However, C-reactive protein detecting or excluding complicated appendicitis at a similar rate to AppendistatTM suggests that the latter does not have a significant advantage in clinical practice.

AMAÇ: Safra kesesi taþý olan ileri yaþ ve ek hastalýða sahip hastalar, takiplerinde gangrenöz ve perfore kolesistit tablosu ile karþý karþýya kalabilmektedir. Literatürde dinamik thiol/disülfid homeostezisinin; detoksifikasyonda, antioksidan korumada, enzimatik reaksiyonlarýn düzenlemesinde, apoptoziste ve hücresel sinyal mekanizmalarýnda önemli rol oynadýðý gösterilmiþtir. Çalýþmamýzda, kolelityazis, akut/kronik kolesistit ve perfore kolesistit olgularýnda ÝMA ve thiol disülfit homeostazýnýn operasyon öncesi taný koymadaki etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmaya Þubat 2019–Mayýs 2020 tarihleri arasýnda kolesistektomi operasyonu amaçlý Ankara Þehir Hastanesi Genel Cerrahi Kliniði’ne baþvuran 66 hasta dahil edildi. Hastalar, kolelityazis nedeniyle ameliyata alýnan (Grup 1), kolesistit nedeniyle ameliyata alýnan (Grup 2) ve perfore safra kesesi nedeniyle ameliyata alýnan (Grup 3) olmak üzere üç gruba ayrýldý. Hastalarýn demografik veriler, kolesistit öyküsü, kronik hastalýk öyküsü, ameliyat öncesi ve sonrasý çalýþýlan WBC, amilaz, lipaz ve karaciðer fonksiyon testleri (AST, ALT) kayýt edildi. Hepatobiliyer ultrasonografide safra kesesi görünümü deðerlendirildi. Ameliyat süresi, perikolesistik yapýþýklýklar, hastanede kalýþ süresi, vücut kitle indeksi (VKÝ), ameliyat sonrasý komplikasyonlar, spesimen patoloji sonuçlarý kayýt altýna alýndý. Ek olarak hastalardan ameliyat öncesi alýnan kanda thiol/disülfid ve ÝMA deðerleri çalýþýldý.
BULGULAR: Adezyon deðeri 0 olanlarýn native thiol ve total thiol ortalamalarý adezyon deðeri 1, 2 ya da 3 olanlara göre anlamlý derecede yüksek izlendi. Ayrýca adezyon deðeri 2 ya da 3 olanlarýn disülfid, disülfid/native thiol, native thiol/total thiol oranlarý ve ÝMA deðerleri adezyon deðeri 0 olanlara göre anlamlý derecede yüksekti. Normal kolesistektomi olanlarýn native thiol ve total thiol ortalamalarý diðerlerine göre daha yüksek iken, perfore safra kesesi nedeniyle kolesistektomi olanlarýn disülfid, native thiol/total thiol oraný ve ÝMA ortalamalarý da diðer gruplardan daha yüksek olarak izlendi. Perfore safra kesesi nedeniyle kolesistektomi olanlarýn ameliyat öncesi WBC ortalamasý da diðer gruplara göre anlamlý olarak daha yüksekti. Son olarak native thiol ve total thiol deðerleri ile yaþ, ameliyat süresi ve hastanede kalýþ süresi arasýnda negatif yönde, VKÝ ile pozitif yönde istatistiksel olarak anlamlý derecede bir iliþki bulunmakta idi.
TARTIÞMA: Ameliyat öncesi olarak perfore safra kesesi tanýsý koymada thiol/disülfid hemostazý ve ÝMA paremetrelerinin deðerlendirilmesinin intraoperatif olarak karþýlaþýlabilecek zorluklarý önceden tahmin etmede etkin ve güvenilir bir yöntem olarak kullanýlabileceði düþüncesindeyiz.

BACKGROUND: In the presence of advanced age and comorbidities, patients with gallstones may face gangrenous and perforated cholecystitis during their follow-up. In the literature, dynamic thiol/disulfide homeostasis has been shown to play an important role in detoxification, antioxidant protection, regulation of enzymatic reactions, and apoptosis and cellular signaling mechanisms. In this study, we aimed to evaluate the efficacy of IMA and thiol/disulfide homeostasis in the preoperative diagnosis of patients with cholelithiasis, acute/chronic cholecystitis, and perforated gallbladder.
METHODS: Sixty-six patients that presented to the General Surgery Clinic of Ankara City Hospital for a cholecystectomy operation between February 2019 and May 2020 were included in this study. The patients were divided into three groups depending on the condition for which they were scheduled for surgery: cholelithiasis, cholecystitis, and perforated gallbladder. The demographic data, history of cholecystitis, chronic disease, white blood cell (WBC), amylase, lipase and liver function tests (AST and ALT) were recorded before the operation. Gallbladder appearance was evaluated using hepatobiliary ultrasonography. The duration of surgery, pericholecystic adhesions, hospital stay, body mass index (BMI), postoperative complications, and pathology results of specimens were recorded. In addition, thiol/disulfide and IMA values were analyzed in the blood samples taken from the patients preoperatively.
RESULTS: The mean native thiol and total thiol values of the patients with an adhesion score of 0 were significantly higher than those with an adhesion score value of 1, 2 or 3. In addition, the disulfide, disulfide/native thiol, native thiol/total thiol and IMA values of the cases with an adhesion score of 2 or 3 were significantly higher than those with an adhesion score of 0. The native thiol and total thiol averages of the patients with normal cholecystectomy were higher than the others. The disulfide, native thiol/total thiol and IMA averages of those who underwent cholecystectomy due to a perforated gallbladder were also higher than the other groups. The mean preoperative WBC of the patients who underwent cholecystectomy due to a perforated gallbladder was also significantly higher than the other groups. Lastly, the native thiol and total thiol values had a statistically significant negative correlation with age, operation time, and hospital stay, and a statistically significant positive relationship with BMI.
CONCLUSION: We consider that in the preoperative diagnosis of the perforated gallbladder, the evaluation of thiol/disulfide hemostasis and IMA parameters can be used as an effective and reliable method to predict intraoperative difficulties.

AMAÇ: Serebral otoregülasyon, arteriyel kan basýncýndaki büyük deðiþikliklere raðmen kararlý durum serebral kan akýmýnýn sabit kalmasýdýr. Ýnhalasyon anestezikleri serebral vazodilatörlerdir. <1 MAC deðerlerinde, net etki serebral kan akýmýnda ýlýmlý bir azalma ve karbondioksite yanýt verebilirliðin korunmasýdýr. Bu çalýþmanýn amacý, genel anestezi altýnda akýþ saptýrýcý cihaz yerleþimi uygulanan hastalarda kararlý durum sevofluran anestezisinin hemodinamik ve serebral arter çap ölçümleri üzerindeki etkisini araþtýrmaktýr.
GEREÇ VE YÖNTEM: Genel anestezi altýnda akýþ saptýrýcý cihaz yerleþimi yapýlan 18–70 yaþ arasý 46 hasta dahil edildi. Hastalara rutin monitorizasyon yapýldý. Ortalama arter basýnç (OAB) deðerleri kaydedildi. Anterior yerleþimli anevrizmasý olan hastalarýn Dijital Subtraksiyon Anjiyografi (DSA) görüntülerinden internal karotis arter, orta serebral arter ve anterior serebral arter çap ölçümleri yapýldý. Posterior yerleþimli anevrizmasý olan hastalarýn DSA görüntülerinden baziller arter, sað posteriyor serebral arter ve sol posteriyor serebral arter çap ölçümleri yapýldý. Bu ölçümler ameliyat öncesi ölçümler olarak kayýt edildi. Ayný hastalarýn kararlý durum sevofluran anestezisi altýnda gerçekleþtirilen akýþ saptýrýcý cihaz yerleþtirme iþlemi öncesinde yapýlan DSA görüntülerinden ayný ölçümler gerçekleþtirildi. Bu ölçümler ameliyat sýrasýnda ölçümler olarak kayýt edildi.
BULGULAR: Hastalarýn yaþ ortalamasý 56.6±15.1’idi. Hastalarýn indüksiyon öncesi OAB; 76.28±5.13 mmHg, indüksiyon sonrasý OAB; 64.36±3.23 mmHg ve sevoflurane anestezisi sýrasýnda OAB; 68.26±4.30 mmHg idi ve istatistiksel olarak anlamlý farklýlýk vardý. Anteriyor serebral arter çaplarýnýn ameliyat öncesi ve ameliyattaki deðerleri arasýnda istatistiksel olarak anlamlý farklýlýk gözlendi. OAB deðiþim yüzdesi ile internal karotis arter çap deðiþim yüzdesi arasýnda (p<0.001, p=-0.785) kuvvetli, orta serebral arter çap deðiþim yüzdesi arasýnda (p=0.033, p=-0.338) orta düzeyde bir iliþki mevcuttu.
TARTIÞMA: Akýþ saptýrýcý cihaz yerleþimi uygulanan hastalarda, <1 MAC sevofluranin hemodinamik etkisi vardýr ve serebral arter çaplarýnda anlamlý olarak vazodilatasyon yapmaktadýr.

BACKGROUND: Cerebral autoregulation is a steady-state of cerebral blood flow despite major changes in arterial blood pressure. Inhalation anesthetics are cerebral vasodilators. In <1 MAC values, the net effect is a moderate decrease in cerebral blood flow and maintenance of responsiveness to carbon dioxide. This study aims to investigate the effects of steady-state sevoflurane anesthesia on hemodynamic and cerebral artery diameter measurements in patients undergoing flow diverter device placement under general anesthesia.
METHODS: Forty-six patients aged 18–70 years who underwent flow diverter devices under general anesthesia were included in this study. Routine monitoring was performed on the patients. Mean arterial pressure (MAP) values were recorded. Internal carotid artery, middle cerebral artery and anterior cerebral artery diameter measurements were made from digital subtraction angiography (DSA) images of patients with anterior aneurysms. Baseline artery, right posterior cerebral artery and left posterior cerebral artery diameter measurements were made from DSA images of patients with posterior aneurysms. These measurements were recorded as preoperative measurements. The same measurements were made from the DSA images performed before the Flow diverter device placement procedure performed under steady-state sevoflurane anesthesia for the same patients. These measurements were recorded as peroperative measurements.
RESULTS: The average age of the patients was 56.6±15.1. The MAP of the patients before induction was 76.28±5.13 mmHg, MAP after induction was 64.36±3.23 mmHg, and MAP during sevoflurane anesthesia was 68.26±4.30 mmHg, there was a statistically significant difference. There was a statistically significant difference between the preoperative and perioperative values of anterior cerebral artery diameters. There was a strong relationship between the MAP change percentage and the ICA diameter change percentage (p<0.001, p=-0.785) and a moderate relationship between the MCA diameter change percentage (p=0.033, p=-0.338).
CONCLUSION: In patients undergoing flow diverter devices, <1 MAC sevoflurane has a hemodynamic effect and creates significant vasodilation in the cerebral artery diameters.

AMAÇ: Medikolegal açýdan sorun oluþturmuþ testis torsiyonu (TT) olgularýný inceleyerek, bu gibi durumlarda týbbi ihmal veya yanlýþ uygulamaya neden olmuþ belirteçleri tanýmlamak ve testis torsiyonu olgularýnýn týbbi yönlerini karakterize etmek amacýyla bir inceleme yaparak sizlere sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 2004–2019 yýllarý arasýnda Türkiye’nin farklý hastanelerinde gerçekleþtirilmiþ müdahaleler sonucu, orþiektomi olan ve Türkiye Cumhuriyeti Adalet Bakanlýðý Adli Týp Kurumu’nda týbbi uygulama hatasý bakýmýndan incelenen 53 testis torsiyonu olgusuna ait veriler geriye dönük olarak deðerlendirildi.
BULGULAR: Olgularýn median yaþý dokuz yýldýr. Torsiyon olgularýn %43.4’ünün (n=23) sol tarafýnda, %54.7’sinin (n=29) sað tarafýnda, %1.9’unun (n=1) ise iki taraflý testis torsiyonu izlenmiþtir. Ön tanýlar incelendiðinde; %58.5 (n=31) epididimorþit, %13.2 (n=7) üriner enfeksiyon, %9.4 (n=5) hidrosel, %7.5 (n=4) renal kolik ve diðer ön tanýlar testis kontüzyonu, gastroenterit, inguinal herni ve akut apandisit olarak saptanmýþtýr. Baþvuru ile TT tanýsý arasý geçen süre, ortalama 59.0±11.2 saattir. Hastayý ilk deðerlendiren doktor ile baþvuruda skrotal muayene yapma durumu arasýnda istatistiksel olarak anlamlý iliþki saptanmýþtýr (p=0.008; p<0.01). Acil servis hekimlerinde skrotal muayene yapma oraný ürologlardan düþüktür. Malpraktis açýsýndan baðýmsýz bir uzman tarafýndan ileri incelemeye gerek görülen ve adli týp kurumuna gelen hasta dosyalarýnda suçlanan hekimler; 25 (%47.2) üroloji uzmaný, 22 (%41.5) acil servis uzmaný, dört (%7.5) pediatrist ve iki (%3.8) radyoloji uzmanýydý.
TARTIÞMA: Hekimler medikolegal kaygýlarýndan önce hasta saðlýðý açýsýndan bu aksaklýlýklarýn mümkün olduðu yaþanmamasý için doðru taný ve tedavi için gerekli deðerlendirmeleri yapmalýdýr. Doðru taný için hekimlerin bilinçlendirilmesi, hekimlerin bilgi ve bilinç düzeyinin arttýrýlmasý ve sürecinin zamana karþý olmasý nedeniyle klinik olarak þüphe edilmesi halinde hastanýn acil ameliyat edilmesi uygun gözükmektedir.

BACKGROUND: By examining patients with testicular torsion (TT) that caused problems in medicolegal terms, the present study aims to define markers causing medical neglect or malpractice in similar conditions and perform a retrospective examination to characterize the medical aspects of patients with TT.
METHODS: In this study, 53 patients who underwent orchiectomy for TT following interventions made between 2004 and 2019 in different hospitals of Turkey and had satisfactory clinical findings in their files based on medicolegal inspections were included.
RESULTS: The median age of the patients was nine years. Twenty-three (43.4%) of the patients had TT on the left side, 29 (54.7%) had TT on the right side, and one (1,9%) patient had bilateral TT. It was noticed that 31 (58.5%) patients had epididymo-orchitis (EO), seven patients had (13.2%) urinary infection, five (9.4%) patients had a hydrocele, and four (7.5%) patients had renal colic, and the others had testicle contusion, gastroenteritis, inguinal hernia, and acute appendicitis as misdiagnoses. The mean time that passed between admission and TT diagnosis was detected as 59±11.2 hours. A statistically significant relation was detected between the branch of the physician who first evaluated the patients and the presence of performing scrotal examination and imaging during admission. The ratio of physical scrotal examinations by emergency service physicians was lower than with the urologists. Among the preliminary examiner allowed to be an advanced evaluation for the possibility of missing diagnosis by an independent specialist physicians, 25 (47.2%) were urologists, 22 (41.5%) were emergency service physicians, four (7.5%) were pediatricians, and two (3.8%) were radiologists.
CONCLUSION: Physicians should perform the required evaluations for a suitable diagnosis and treatment by putting aside their medicolegal concerns and prevent the problems by giving priority to patient health. For the correct diagnosis and proper management of TT, it is necessary to increase the information levels of physicians, and patients should be explored urgently in the event of any clinical suspicion.

AMAÇ: Bu çalýþmanýn amacý tüberkülozun (TB) endemik olduðu bir bölgede granülomatöz apandisitin (GAp) ayýrýcý tanýsýnda real-time polymerase chain reaction (PCR) ve interferon-gamma release assay’in (IGRA) kullanýlabilirliliðini sunmaktýr.
GEREÇ VE YÖNTEM: Akut apandisit ön tanýsýyla apendektomi yapýlan ve histopatolojik tanýsý GAp olan 16 hasta geriye dönük olarak analiz edildi. Parafine gömülmüþ doku bloklarýnda TB basiline ait DNA’nýn varlýðýný göstermek için real-time PCR yöntemi kullanýldý. Periferik kanda TB basiline spesifik interferon gamanýn olup olmadýðýný tespit etmek için IGRA testi kullanýldý.
BULGULAR: Yaþlarý 21 ile 82 yýl arasýnda deðiþen 16 hasta (erkek=10, kadýn=6) bu çalýþmaya dahil edildi. Tüm hastalarda akut apandisit vardý ve üç hastada ayrýca apendikste perforasyon vardý. Histopatolojik olarak tüm apendektomi spesimenlerinde nekrotizan granülomatöz enflamasyon tespit edildi. Ehrlich-Ziehl-Neelsen ile boyanan hiçbir patoloji preparatýnda aside dirençli basil tespit edilmedi. GAp’li tüm hastalarýn parafine gömülmüþ doku bloklarýnda Real-time PCR çalýþýldý fakat sadece üç hastada TB basiline ait DNA amplifiye edildi. GAp’li 12 hastanýn periferik kan numunesinde IGRA çalýþýldý ve sonuçlar aþaðýdaki gibi raporlandý: negatif (n=9), pozitif (n=2) ve belirsiz (n=1).
TARTIÞMA: Özellikle TB’nin endemik olduðu bölgelerde GAp’nin ayýrýcý tanýsýnda öykü, histopatolojik bulgular, doku PCR, kan IGRA ve klinik bulgularýn birlikte kullanýmýnýn önemli olduðuna inanýyoruz. Ayrýca, makroskobik olarak normal görünse bile tüm apendektomi spesimenlerinin histopatolojik deðerlendirme için laboratuvara gönderilmesini öneriyoruz.

BACKGROUND: This study aims to present the usability of real-time polymerase chain reaction (PCR) and interferon-gamma release assay (IGRA) in the differential diagnosis of granulomatous appendicitis (GAp), especially in areas where tuberculosis (TB) is endemic.
METHODS: Sixteen patients underwent appendectomy with presumed diagnosis of acute appendicitis were retrospectively analyzed for histopathological diagnosis of GAp. Real-time PCR method was used to show the whether presence of DNA of the tubercle bacilli in paraffin-embedded tissue blocks. IGRA test was used to investigate whether tubercle bacilli- specific interferon gamma was present in peripheral blood.
RESULTS: Sixteen patients (male: 10 female: 6) aged between 21 and 82 years were included in this study. All patients had acute appendicitis and three of them also had appendiceal perforation. Histopathologically, necrotizing granulomatous inflammation was detected in all appendectomy specimens. Acid-fast bacilli were not detected in any of the pathology slides stained with Ehrlich-Ziehl-Neelsen. Real-time PCR was studied in paraffin-embedded tissue blocks of all patients with GAp, but the TB bacilli DNA was amplified in only three patients. IGRA test was studied in peripheral blood samples of 12 patients with GAp and results were as follows: negative (n=9), positive (n=2) and indeterminate (n=1).
CONCLUSION: We believe that the use of anamnesis, histopathological findings, tissue PCR, blood IGRA and clinical findings together are important for differential diagnosis of GAp, especially where TB is endemic. We also suggest that all appendectomy specimens should be sent to the laboratory for histopathological evaluation even if specimens appear macroscopically normal.

AMAÇ: Rektus kýlýf hematomu akut karýn aðrýsýnýn nadir görülen ve sýklýkla gözden kaçan nedenlerinden birisidir. Çoðunlukla ileri yaþ ve yandaþ hastalýklarýn eþlik ettiði bu hastalarýn yönetiminde doðru taný ve tedavi yaklaþýmlarýyla, gereksiz cerrahi müdahalelerden kaçýnarak olumlu sonuçlar alýnabilmektedir. Bu çalýþmanýn amacý, rektus kýlýf hematomu tanýlý hastalarýn yönetimindeki algoritma ve optimal tedavi stratejileri eksikliðine olgu yönetim deneyimimizle katkýda bulunmaktýr.
GEREÇ VE YÖNTEM: Çalýþmamýzda Mayýs 2010–Temmuz 2018 tarihleri arasýnda rektus kýlýf hematomu tanýsý ile tedavi uygulanan hastalarýn demografik özellikleri, özgeçmiþleri, tanýya götüren fiziksel incelemeleri, laboratuvar ve görüntüleme yöntemlerindeki bulgularý, tedavi süreç ve yöntemleri, komplikasyonlarý, morbidite ve mortalite oranlarý, yatýþ süresi ve uzun süreli takip sonuçlarý geriye dönük olarak hasta dosyalarý, hastane bilgisayar kayýt sistemi ve görüntüleme arþivleri incelenerek elde edildi. Elde edilen verilerin analizi Microsoft Excel ve IBM SPSS Statistics 24 kullanýlarak deðerlendirildi.
BULGULAR: Çalýþmaya dahil edilen 31 hastanýn yaþ ortalamasý 63.03 yýl (24–85 yýl) olup; kadýn/erkek oraný (21/10) 2.1 idi. En sýk görülen semptom karýn aðrýsý (%100) olmakla beraber; 25 olguda (%80.6) karýn duvarý kitlesi tespit edildi. Antikoagülan ve antiplatelet tedavisi alan 25 olgu (%80.6) vardý. Olgularda taný; 11’inde (%45.4) yalnýzca bilgisayarlý tomografi; beþinde (%16.1) yalnýzca ultrasonografi ve 15’inde (%33.3) ise bilgisayarlý tomografi + ultrasonografi yardýmýyla konuldu. Sekiz olgu (%25.8) Tip 1, 10 olgu (%32.2) Tip 2 ve 13 olgu (%41.9) Tip 3 rektus kýlýf hematomu olarak deðerlendirildi. Ortalama International Normalized Ratio (INR) deðeri 2.59 olarak bulundu. Üç olguda (%9.6) kanama kontrolü cerrahi müdahale ile saðlanýrken; 28 olguda (%90.3) ise konservatif tedavi uygulandý. Olgular ortalama 7.48 gün (4–21) takip edilmiþ olup; 29 olgu (%93.5) taburcu edilirken; cerrahi yapýlan bir olgu ameliyat sonrasý beþinci günde, konservatif takip edilen bir olgu ise yatýþýnýn 14. gününde kaybedildi (%6.45 mortalite). Konservatif ve cerrahi yöntemle takip edilen olgularýn mortalite oranlarý sýrasýyla %3.5 ve %33.3 idi.
TARTIÞMA: Akut karýn aðrýsý, göbek altý palpable veya görüntüsel yöntemlerle desteklenen kitlesi olup; antikoagülan tedavi alan, þiddetli öksürük ataklarý olan ileri yaþlý hastalarda rektus kýlýf hematomundan þüphe edilmelidir. Klinik þüphe halinde ultrasonografi veya bilgisayarlý tomografi yapýlmalýdýr. Erken ve doðru taný konservatif tedavinin baþarýlý olmasýný ve gereksiz cerrahi giriþimleri önler. Klinisyen tecrübesinin ön planda olduðu bu olgularda, olgu çalýþmalarý sunularýnýn artmasýyla birlikte yeni bir etkili algoritma sisteminin ve taný için kýlavuzlarýn tanýmlanacaðýný umuyoruz.

BACKGROUND: Rectus sheath hematoma is a rare and frequently misdiagnosed cause of acute abdominal pain. In the management of the patients with rectus sheath hematoma, which are mostly with advanced age and comorbid diseases, positive results can be obtained by avoiding unnecessary surgical procedures with correct diagnosis and treatment approaches. The presented study aims to contribute to the lack of algorithms and optimal treatment strategies in the management of rectus sheath hematoma patients with the description of our experience in their management.
METHODS: Patients who underwent treatment with the diagnosis of rectus sheath hematoma between May 2010 and July 2018 were retrospectively analyzed. Demographic characteristics, medical histories, physical and laboratory findings and imaging methods, treatment processes, complications, morbidity, mortality, length of hospitalization and long-term follow-up results were searched. Data were analyzed from patient files, hospital computer registry system and radiology archives. Data analysis was performed using Microsoft Excel and IBM-SPSS-Statistics-24.
RESULTS: The mean age of the 31 patients was 63.03 years (24–85 years). The female/male ratio (21/10) was 2.1. The most common presenting sign or symptom was abdominal pain (100%), followed by abdominal wall mass in 25 patients (80.6%). Twenty-five patients (80.6%) were receiving some form of anticoagulation and antiplatelet therapy. Diagnosis was confirmed by Computed Tomography in 11 (45.4%), Ultrasonography in five (16.1%) and Computed Tomography with Ultrasonography in 15 (33.3%). Eight patients (25.8%) were evaluated as Type-1, 10 (32.2%) as Type-2 and 13 (41.9%) as Type-3. Mean International Normalized Ratio (INR) value of patients was 2.59. Bleeding was controlled by surgery in three cases (9.6%). The conservative approach was preferred in 28 cases (90.3%). 29 (93.5%) patients were discharged after an average hospital stay of 7.48 days (4–21). One patient died on the postoperative 5th day and other on the 14th day of conservative treatment (6.45% mortality). The mortality rate of conservatively and surgically treated patients was 3.5% and 33.3%, respectively.
CONCLUSION: Rectus sheath hematoma should be suspected in elderly patients using anticoagulants with acute abdominal pain, severe cough attacks and an umbilical palpable or radiologically supported mass. Computed Tomography and Ultrasonography should be performed in case of clinical suspicion. Early and correct diagnosis ensures successful conservative treatment and prevents unneces-sary surgical procedures. In the management of cases where clinician experience is at the forefront, we are hopeful that a new effective algorithm system and guidelines for the diagnosis will be identified after increasing the presentations of case series and experiences.

AMAÇ: Ön çapraz bað yýrtýklarýnýn rekonstrüksiyonunda kullanýlan Transfix ve Ziploop ile ToggleLoc sistemlerinin maliyet-etkinlik açýsýndan karþýlaþtýrýlmasý amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Bu çalýþma, kliniðimizde 2011 ve 2016 yýllarý arasýnda Transfix ve Ziploop ile ToggleLoc sistemlerinin kullanýldýðý ön çapraz bað rekonstrüksiyonu yapýlan hastalarýn maliyet etkinliði analizidir. Bu çalýþma geriye dönük ve kesitsel olup hastalarýn demografik, klinik ve finansal verilerinin deðerlendirilmesiyle yapýlmýþtýr. Cerrahinin etkinliði, ön çapraz bað rekonstrüksiyonu olan hastalarda Lysholm Diz Skoru Ölçeði’yle belirlendi. Ýki sistemi maliyet-etkinlik oraný ile karþýlaþtýrdýk.
BULGULAR: Çalýþmaya toplam 103 hasta dahil edildi. Her iki grup Lysholm Diz Skor Ölçeði’ne göre deðerlendirildiðinde istatistiksel olarak gruplararasýnda etkinlik farký bulunmadýðý tespit edildi. Ziploop ile ToggleLoc tekniðinin maliyet etkinlik oraný 254.57 iken Transfix tekniðinin maliyet etkinlik oraný 378.33 olarak bulunmuþtur.
TARTIÞMA: Elde ettiðimiz sonuçlara göre, Ziploop ile ToggleLoc tekniði ön çapraz bað rekonstrüksiyonunda Transfix tekniðinden daha maliyet-etken bir yöntem olarak bulundu.

BACKGROUND: To evaluate the cost-effectiveness of the reconstruction of the anterior cruciate ligament tears using either ToggleLoc with ZipLoop or Transfix systems.
METHODS: This study is a cost-effectiveness analysis of patients with anterior cruciate ligament reconstruction, ToggleLoc with ZipLoop and Transfix systems in our clinic between 2011 and 2016. This study was a retrospective cross-sectional study of patient’s demographic, clinical and financial data. The effectiveness of surgery on patients with anterior cruciate ligament reconstruction was determined by the Lysholm Knee Score Scale. We compared two systems with the cost-effectiveness ratio.
RESULTS: In this study, 103 patients were included. According to the Lysholm Knee Score Scales in both groups, the findings showed that there was no difference in effectiveness between them. The ToggleLoc with ZipLoop technique was cost-effectiveness ratio 254,57 and the Transfix technique cost-effectiveness ratio was 378,33.
CONCLUSION: According to our results, ToggleLoc with ZipLoop technique was a more cost-effective method than the Transfix technique in the anterior cruciate ligament reconstruction.

AMAÇ: Bu çalýþmada, eklem içi uzanýmlý distal radius kýrýklarýnýn tedavisinde kapalý redüksiyon perkütan pinlemeye (KRPP) karþýn açýk redüksiyon internal fiksasyon (ARÝF) tedavi yöntemlerinin dört yýllýk sonuçlarý karþýlaþtýrýlmýþtýr.
GEREÇ VE YÖNTEM: KRPP (n=19; 11 erkek ve sekiz kadýn) ile tedavi edilen tek taraflý intraartiküler distal radius kýrýðý (tip B ve C) olan ve ARÝF yapýlan (n=24; 14 erkek ve 10 kadýn) toplam 43 hasta geriye dönük olarak incelendi. Ortalama takip süresi kRPP grubunda 50.3 ay (12–74) ve ARÝF grubunda 45.2 ay (40–65) idi. Ortalama yaþ KRPP grubunda 50.8 (29–73), ARÝF grubunda 51.5 (19–75) idi. Hastalar son takipte fonksiyonel ve radyolojik olarak deðerlendirildi.
BULGULAR: Takip, yaþ ve cinsiyet açýsýndan gruplar arasýnda istatistiksel olarak anlamlý fark yoktu. Her ne kadar kavrama gücü ve hareket aralýðý ile ilgili istatistiksel bir fark olmasa da ARÝF grubunda kol, omuz ve el sorunlarý skoru (Q-DASH) daha iyiydi. Voler tilt ve radyal yükseklik ölçümleri ARÝF grubunda istatistiksel olarak anlamlý derecede daha iyi idi. Dejeneratif artrit KRPP grubunda %63 ve ARÝF grubunda %41 idi ve istatistiksel olarak anlamlý fark yoktu.
TARTIÞMA: Dört yýllýk takip sonucunda volar plak ile ARÝF yapýlan eklem içi uzanýmlý distal radius kýrýðý olan hasta grubunda, KRPP’den daha iyi fonksiyonel ve radyolojik sonuçlara sahip olduðu saptandý.

BACKGROUND: This study was performed to compare the results of closed reduction percutaneous pinning (CRPP) versus open reduction internal fixation with a volar locking plate (ORIF) in the treatment of intraarticular distal radius fractures (IDRF) average four-year follow-up.
METHODS: In this study, 43 patients had unilateral intraarticular distal radius fractures (type B and C) treated with CRPP (n=19; 11 males and eight females) and ORIF (n=24; 14 males and 10 females) were retrospectively evaluated. The mean follow-up was 50.3 months (12–74) at the CRPP group and 45.2 months (40–65) at the ORIF group. The mean age was 50.8 years (29–73) in the CRPP group and 51.5 (19–75) in the ORIF group. The patients were evaluated functionally and radiologically at the last follow-up.
RESULTS: There was no statistically significant difference between the groups concerning follow-up, age, and gender. However, there was no statistical difference concerning grip power and the range of motion. The Disabilities of the Arm, Shoulder and Hand Score (Q-DASH) was better in the ORIF group. Voler tilt and radial height measurements were statistically significantly better in the ORIF group. Degenerative arthritis was 63% in the CRPP group and 41% in the ORIF group, and there was no statistically significant difference.
CONCLUSION: ORIF with a volar locking plate has better functional and radiological results than CRPP in IDRF patients’ average four-year follow-up.

AMAÇ: Kemik kalitesi ileri derecede bozuk olan ve nispeten iyi olan hastalarýn femoral stem saðkalým oranlarýný karþýlaþtýrarak osteoporozun protez saðkalýmý uzerindeki etkisini araþtýrmak.
GEREÇ VE YÖNTEM: 2011–2015 yýllarý arasýnda ortopedi ve travmatoloji kliniðinde femur boyun kýrýðý tanýsýyla sementsiz karekesit femoral stem ve unipolar baþ ile tedavi edilen, son kontrollerine gelen ve en az üç yýllýk takip sonuclarý elimizde olan 61 hasta belirlendi. Radyografik deðerlendirme için hastalarýn ameliyat öncesi grafilerinden pelvis AP grafilerine bakýldý. Kortikal kemik kalitesini deðerlendirmek amacýyla Dorr sýnýflamasý kullanýldý. Dorr sýnýflamasýna göre tip A olan hastamýz yoktu. Çalýþmaya dahil edilen hasta grubu ileri osteoporotik tip C ve ýlýmlý osteoporotik tip B olmak üzere iki gruba ayrýldý. Hastalarýmýzýn 30 tanesi Dorr sýnýflamasýna göre tip B, 31 tanesi tip C idi.
BULGULAR: Dorr sýnýflamasýna gore kortikal kemik kaliteleri açýsýndan sýnýflandýrdýðýmýz hastalarda femoral komponentin saðkalýmlarý Engh ve ARA kriterleri kullanýlarak deðerlendirildi. Dorr sýnýflamasýna göre Tip B ve Tip C gruplarýnýn ARA skoru ile iliþkisi karþýlaþtýrýldý. Dorr tip B grubunda ARA; medyan 5 (min 3–maks 6), tip C grubunda medyan 5 (min 3–maks 6) olarak bulundu. Bu iki grup istatistiksel olarak Mann-Whitney U testi ile kýyaslandý. Her iki grup arasýnda ARA skorlarý açýsýndan istatistiksel olarak anlamlý fark saptanmadý (p=0.24 >0.05). Yine benzer þekilde her iki grup arasýnda femoral komponent saðkalým kriteri olan Engh deðerleri karþýlaþtýrýldý. Dorr tip B olan grupta Engh deðerleri; medyan 16.5 (min 9–maks 24), Dorr tip C grubunda; medyan 14 (min 9-maks 24) olarak bulundu. Bu iki grup istatistiksel olarak Mann-Whitney U-testi kullanýlarak karþýlaþtýrýldý. Her iki grubun Engh deðerleri arasýnda anlamlý farklýlýk saptanmadý (p=0.061 >0.05). Bizim verilerimizde ileri osteoporotik olarak kabul etiðimiz tip C grubu ile ýlýmlý osteoporotik kabul ettiðimiz tip B grubu arasýnda hem ARA skorlarý, hem de Engh gevþeme skorlarý acýsýndan femoral komponentlerdeki gevþeme deðerlendirildiðinde istatistiksel olarak anlamlý fark saptanmadý.
TARTIÞMA: Çalýþmamýz sementsiz kalça artroplastisinin ileri yaþlý, osteoporotik hastalarda dahi, ameliyatta ve ameliyat sonrasý ilave riskler getirmeden, hem de radyolojik ve klinik sonuçlarý bakýmýndan da yüzgüldürücü bir þekilde uygulanabilirliði sonucunu desteklemektedir.

BACKGROUND: The present study aims to investigate the effects sof osteoporosis on prosthesis survival by comparing the femoral stem survival rates of patients with poor and relatively good bone quality.
METHODS: We retrospectively investigated 61 patients with collum femoris fractures who were treated with cementless rectangular stems between 2011 and 2015 in the Orthopaedics and Traumatology Clinic of Taksim Training and Research Hospital. The preoperative pelvic anterior-posterior radiographs of the patients were evaluated. The patients were evaluated according to the Dorr classification, and no case with a type A femur was found. The patients were divided into two groups as advanced osteoporotic type C and moderate osteoporotic type B. Thirty patients were type B according to the Dorr classification and 31 were osteoporotic type C.
RESULTS: The femoral component survival was evaluated using the Engh and ARA criteria. The relationship of the ARA score with type B and type C groups was evaluated. The median ARA score was five (min 3-max 6) for both types. These two groups were also statistically compared concerning the ARA scores using the Mann-Whitney U test, which revealed no statistically significant difference (p=0.24 >0.05). The Engh values, another criterion for the survival of femoral components, were also compared. The median Engh values were 16.5 (min 9-max 24) for the Dorr type B group and 14 (min 9-max 24) for the type C group. According to the Mann-Whitney U test, there was no significant difference between the Engh values of the two groups (p=0.061 >0.05). Lastly, no statistically significant difference was found in the ARA or Engh loosening scores between the type C advanced osteoporotic group and the type B moderate osteoporotic group.
CONCLUSION: Our study supports the conclusion that cementless hip arthroplasty can be applied even in advanced elderly and osteoporotic patients without additional intraoperative or postoperative risks.

AMAÇ: Ürolojik acil olgulardan olan penil fraktürde erken dönem cerrahi onarým yapýlan hastalarla konservatif tedaviyle iyileþen hastalarý uzun dönemde cinsel fonksiyonlar bakýmýndan karþýlaþtýrmak.
GEREÇ VE YÖNTEM: Kliniðimize Ocak 2010 ile Ocak 2020 tarihleri arasýnda penil fraktür nedeniyle baþvuran toplam 42 hastanýn verileri geriye dönük olarak incelendi. Hastalar erken dönemde ameliyat edilenler ve konservatif olarak takip edilenler olarak iki gruba ayrýldý. Hastalarýn ameliyat öncesi ve sonrasý bulgularý ile uzun dönem takipte Uluslararasý Erektil Fonksiyon Ölçeði (IIEF-6) skorlarý karþýlaþtýrýldý.
BULGULAR: Hastalarýn median yaþý 35 (20–65) yýl ve median takip süreleri 52 (8–120) aydý. Hastalarýn ameliyat sonrasý ortalama IIEF-6 skoru 22.98±6.52 bulundu. Ameliyat sonrasý komplikasyon varlýðý açýsýndan cerrahi yapýlan grupla konservatif izlenen grup arasýnda anlamlý fark bulunmadý (p=0.460). Uzun dönem takipte rüptür alanýnda palpe edilen plak varlýðý konservatif tedavi grubunda anlamlý olarak yüksek bulundu (p=0.041). Ancak IIEF-6 skorlarý bakýmýndan gruplar arasýnda anlamlý fark olmadýðý görüldü (p=0.085).
TARTIÞMA: Penil fraktür hastalarýnda erken cerrahi yapýlanlarla, konservatif izlem yapýlanlar arasýnda uzun dönemde IIEF-6 skorlarý bakýmýndan anlamlý fark yoktur. Ancak konservatif takip edilen hastalarda peniste plak oluþum oraný daha yüksektir. Bu nedenle özellikle rüptür alaný büyük hastalarda acil cerrahi onarým ön planda düþünülmelidir.

BACKGROUND: To compare the patients who underwent early surgical repair of penile fracture, which is one of the urological emergencies, and patients who recovered with conservative treatment concerning long-term sexual functions.
METHODS: The data of 42 patients who applied to our clinic with penile fracture between January 2010 and January 2020 were retrospectively analyzed. The patients were categorized into two groups as early operated and followed-up conservatively. The preoperative and postoperative findings of the patients were compared with the International Erectile Function Scale (IIEF-6) scores in the long-term follow-up.
RESULTS: The median age of the patients was 35 (20–65) years and the median follow-up period was 52 (8–120) months. The postoperative mean IIEF-6 score of the patients was 22.98±6.52. There was no significant difference between the surgical and the conservative groups concerning postoperative complications (p=0.460). In the follow-up period, the presence of palpable plaque on the rupture area was significantly higher in the conservative group (p=0.041). However, there was no significant difference between the groups concerning IIEF-6 scores (p=0.085).
CONCLUSION: Although there is no significant difference in long-term IIEF-6 scores between the two groups, the rate of palpable plaque formation is higher in patients followed-up conservatively. Therefore, early surgical repair should be considered in the foreground, especially in patients with a large rupture area.

AMAÇ: Gebelikte akut batýnýn en sýk obstetrik dýþý cerrahi endikasyonu apandisittir. Gebelikte apandisit gebeliðe baðlý patolojilerle karýþabilmekte, tanýda gecikmeye veya gereksiz cerrahiye yol açabilmektedir. Çalýþmanýn amacý gebelikte appendektomi yapýlan hastalarýn maternal ve neonatal sonuçlarýnýn deðerlendirilmesi olarak belirlendi.
GEREÇ VE YÖNTEM: Çalýþma 2011–2017 yýllarý arasýnda geriye dönük olarak tasarlandý. Akut apandisit öntanýsý ile cerrahiye alýnan gebelerde apandisit saptanma oranlarý, baþvuru ve laboratuvar özellikleri, ameliyat sonuçlarý ve obstetrik sonuçlar deðerlendirildi.
BULGULAR: Toplam 2593 hastaya appendektomi uygulandý, bunlarýn 1154’ü kadýn, 50’si gebe idi. Negatif laparotomi 12 (%16) hastada saptandý. Elli gebe hastanýn altýsý (%12) laparoskopik appendektomi, 44’ü (%88) laparotomi ile appendektomi idi. Hastaneye kabul sonrasý operasyona kadar geçen süre ortalama 10.5±11 saat idi. Maternal mortalite izlenmedi. Dört (%8) hastada preterm eylem nedeniyle prematür doðum gerçekleþti. Hastalarýn ikisi (%4) ikinci trimesterde, ikisi (%4) üçüncü trimesterde idi. Ýkinci trimesterde doðan iki (%4) yenidoðan postpartum hayatýný kaybetti. Bu yenidoðanlardan birinde multipl anomali mevcuttu. Appendektomi perinatal mortalite riskinde artýþ ile karakterize deðildi.
TARTIÞMA: Gebelikte akut apandisit taný ve cerrahisinde gecikme perinatal mortalite riskini artýrabilir, taný ve cerrahide gecikilmemelidir.

BACKGROUND: During pregnancy, the most common indication for non-obstetric surgery in acute abdomen is appendicitis. In pregnancy, appendicitis may be confused with pregnancy-related pathologies and may cause a delay in diagnosis or unnecessary surgery. The present study aims to evaluate the maternal and neonatal outcomes of patients undergoing appendectomy during pregnancy.
METHODS: This study was designed retrospectively between 2011–2017. Appendicitis detection rates, admission and laboratory features, operation results and obstetric results were evaluated in pregnant women who underwent surgery for a preliminary diagnosis of acute appendicitis.
RESULTS: The findings showed that 2593 patients underwent an appendectomy, 1154 of them were women and 50 of them were pregnant. Negative laparotomy was detected in 12 (16%) patients. Six (12%) of these 50 patients had a laparoscopic appendectomy and 44 (88%) had an appendectomy with laparotomy. The mean time to operation after admission to hospital was 10.5±11 hours. No maternal mortality was observed. Preterm labor occurred in four (8%) patients. Two patients (4%) were in the second trimester and two patients (4%) were in the third trimester. Two (4%) newborns born in the second trimester died postpartum. One of these newborns had multiple anomalies. Appendectomy was not characterized by an increased risk of perinatal mortality.
CONCLUSION: Delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy.

Ciddi üreter yaralanmalarýný tedavi etmek için renal ototransplantasyon ilk kez 1963’te Hardy ve arkadaþlarý tarafýndan yapýldý. Bu yöntem travma, renal arter hastalýklarý veya üreteral darlýðýn karmaþýk tedavisinde kullanýlan bir yöntem olmuþtur. Proksimal üreterin yaklaþýk 2/3’ünün iyatrojenik yaralanmasý durumunda, uç uca anastomoz mümkün deðilse, renal ototransplantasyon, ileal üreter interpozisyonu veya nefrektomi alternatif tedavilerdir. Teknoloji ilerledikçe üreterorenoskopi (URS) kullanýmý artmakta ve bu paralel olarak bu iþlem esnasýnda meydana gelen iyatrojenik yaralanmalarda artmaktadýr. Bu tür yaralanmalar genellikle basit delikler þeklindedir (%2–6), ancak zaman zaman üreter avülsiyonlarý da gözlenir (%0.3). Bu makalede sað üreter taþý nedeniyle yapýlan üreterorenoskopi iþlemi sýrasýnda üreter avülsiyonunun geliþmesini takiben renal ototransplantasyonun yapýldýðý bir olgu sunuldu ve tedavi seçenekleri literatür ýþýðýnda tartýþýldý.

Hardy and colleagues carried out “Renal autotransplantation” for the first time in 1963 to treat severe ureter injury and it has evolved as a method used for complex treatment of trauma, renal artery diseases or ureteral stenosis. In case of proximal ureter injury, approximately 2/3 of which is iatrogenic, if the end-to-end anastomosis is not possible, renal autotransplantation, ileal ureter interposition or nephrectomy are alternative treatments. As technology advances, the use of ureterorenoscopy (URS) increases and in parallel with this iatrogenic injuries that occur during the process have increased as well. These types of injuries are generally in form of simple perforations (2–6%), but from time to time ureter avulsions are also observed (0.3%). In this article, a case is presented where renal autotransplantation is made following development of ureter avulsion during ureterorenoscopy process carried out due to right ureteral calculi and treatment options are discussed in the light of literatures.

Pilonidal sinüs, epidermise nüfuz eden kýl gövdelerinin neden olduðu iyi bilinen bir sakrokoksigeal bölge hastalýðýdýr. Granülomatöz reaksiyon, bu kronik enflamatuvar hastalýðýn özelliðidir. Umbilikal pilonidal sinüs, klinik olarak birçok þekilde ortaya çýkabilen ve bazý umbilikal bölgede meydana gelen hastalýklarý taklit eden edinilmiþ bir hastalýktýr. Umbilikal pilonidal sinüs oluþumunda çeþitli risk faktörleri tanýmlanmýþtýr. Umbilikal pilonidal sinüsün tedavisi kanýta dayalý týptan ziyade klinik deneyime dayanýr. Týbbi ya da cerrahi olarak tedavi edilmeyen umbilikal pilonidal sinüs bölgesel ya da generalize enfeksiyonlara neden olabilir. Daha önce hiçbir belirti vermeyen karýniçi perforasyon gösteren umbilikal pilonidal sinüs apsesi olgumuzun, akut karýn ön tanýlarý arasýnda bundan sonra göz önünde bulundurulacaktýr.

Pilonidal sinus is a well-known disease of the sacrococcygeal region, which is caused by hair shafts penetrating the epidermis. The granulomatous reaction is the characteristic of this chronic inflammatory disease. Umbilical pilonidal sinus is an acquired disease that may appear in many guises and mimic several umbilical conditions. Several risk factors for developing the disease have been described. Treatment is based on clinical experience rather than on evidence-based medicine. The umbilical pilonidal sinus, which is not treated medically or surgically, may cause regional or generalized infections. We suggest that our case which has never had symptoms before and has caused acute abdomen, will be considered in the diagnosis of acute abdomen.

Stenli hastalarýn yönetimi, her ne kadar kýlavuzlarda anlatýlsa da, bazý hastalar benzersiz ve sýnýf dýþý olabilir. Bu sunumda, hastanýn perioperatif miyokart hasarýna sebep olabilecek birçok trombotik risk faktörü vardýr. Bu faktörler; çoklu ilaç salýnýmlý stent öyküsü ile birlikte koroner arter hastalýðý, stent trombozu öyküsü, 11 ay önce yerleþtirilmiþ yeni stent ve malignensi ve cerrahi iþleme baðlý hiperkoagülopatidir. Hastanýn ilaç salýnýmlý stent öyküsü, perioperatif kanama ve stent tromboz riskini en aza indirmek için en uygun yöntemi düþündürerek anestezi, cerrahi ve kardiyoloji ekipleri için bir ikilem oluþturmuþtur.

Although the management of a stent patient may appear in the guidelines, some patients may be unique and out of class. In this presentation, the patient had multiple thrombotic risk factors for perioperative myocardial injury. These factors included coronary artery disease with multiple implantations of drug-eluting stent (DES), stent thrombosis history, implantation of a new stent 11months ago and hypercoagulability (due to malignancy and surgical procedure). The patient’s history of DES presented a dilemma for the anesthesiology, surgery, and cardiology teams in considering the optimal method to minimize the risk of perioperative bleeding and stent re-thrombosis.